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Published on: February 5, 2019
Osteoclastic craniectomy for scaphocephaly in infants results in physiological head shapes
M Lehner1, F Ferrari-von Klot2, S Zundel3
1Department of Pediatric Surgery, Dr von Hauner Children's Hospital, Ludwig-Maximilian's-University, Munich, Germany; Department of Pediatric Surgery, Kantonsspital Luzern, Children's Hospital, Lucerne, Switzerland.
Insights
Osteoclastic craniectomy (OC) in infants with scaphocephaly significantly improves head shape and cephalic index (CI). This surgical intervention leads to normal head growth and excellent aesthetic outcomes, with complete re-ossification and no need for further operations.
Area of Science:
- Neurosurgery
- Pediatric Surgery
- Craniofacial Surgery
Background:
- Sagittal synostosis causing scaphocephaly is the most common craniostenosis requiring surgical intervention.
- Optimal treatment for scaphocephaly remains a subject of debate.
- Head circumference and cephalic index (CI) are key indicators of normal head shape in children.
Purpose of the Study:
- To evaluate the effectiveness of osteoclastic craniectomy (OC) in achieving normal head shapes in infants with scaphocephaly.
- To analyze head growth and cephalic index (CI) changes following OC.
Main Methods:
- A cohort of 27 infants with scaphocephaly underwent OC between 2003 and 2011.
- Mean patient age at surgery was 6.75 months, with a mean follow-up of 6.3 years.
- Head growth and CI were monitored and analyzed across three follow-up periods (2-4, 5-7, and 8-10 years).
Main Results:
- Significant increases in head circumference were observed across all follow-up groups (p<0.05).
- The mean CI improved significantly from a preoperative pathological value (0.67) to a normal postoperative value (0.78).
- Complete re-ossification occurred in all patients, with no secondary surgeries required.
Conclusions:
- Osteoclastic craniectomy (OC) is an effective surgical treatment for scaphocephaly in infants.
- The procedure leads to significant improvements in cephalic index (CI) and head shape symmetry.
- OC is recommended for infants aged six to twelve months due to excellent aesthetic and functional outcomes.
Introduction:
Sagittal synostosis leading to scaphocephaly is the most common type of craniostenosis being operated. Different treatment options are known, but the optimal treatment method is still controversial. Head growth indicated by measurements of the head´s circumference and cephalic index (CI) are valid surrogate parameters for normal head shapes in children. The aim of the study was to analyze if osteoclastic craniectomy (OC) in scaphocephaly children at four to ten months of age results in normal head shapes.
Patients And Methods:
Twenty-seven patients with scaphocephaly underwent OC between 2003 and 2011. The mean patient age at the time of surgery was 6.75 months. The body weight was between 6.1 and 9.3 kg, mean 8.0 kg. The average duration of surgery was 108 minutes. The mean blood loss during the procedure was 168 ml and the mean amount of erythrocyte transfusion was 152 ml. The mean time spent on the ICU was 1.48 days and the mean of total hospital stay was 5.81 days. The operative method is described. During the mean follow-up time of 6.3 years (min 3.8, max 10.4, median 7.1) focus was set on the patient´s head growth and cephalic index (CI) following OC. For statistical reason the follow up period was divided into three groups: follow up 2-4 years, 5-7 years and 8-10 years.
Results:
For all cases the total head growth was 9.5cm (mean) during the follow up period of 6.3 years. Analyzing the mean head growth by bootstrapping analysis, the three observational groups showed a significant increase of the head circumference in all cases being analyzed: group 1 p=0.003, group 2 p=0.005 and group 3 p=0.028 Evaluation of the CI showed a statistically significant change from a pathologic value of 0.67 (mean) preoperatively to a normal value of 0.78 (mean) postoperatively during the follow up analyzing all patients. To precise these findings, the bootstrapping analysis showed in the first period an increase of the mean CI not reaching statistical significance (p=0.351). Analyzing the second and third period the CI significantly increased in both groups (p=0.016 and p=0.037). All patients showed a nearly complete re-ossification during the follow up period. No secondary operation was necessary in any patient of this cohort.
Conclusion:
As shown in this single-center observational study, the surgical intervention significantly improved the cephalic index and resulted in a symmetric head shape with excellent aesthetic appearance. The results were not dependent on postoperative helmet therapy, and compliance of caregivers. Re-ossification reached 100% within the observation period. According to these data, we recommend osteoclastic craniectomy as the method of choice in infants six to twelve months of age.
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